New federal laws targeting unexpected medical bills for out-of-network providers will go into affect for Plano health insurance recipients.
With new proposed legislation, Plano health insurance recipients could witness financial relief due to fewer costly and unexpected medical bills.
Many Americans regardless of the type of medical coverage they possess, have at some point witnessed receiving “surprise” bills with exorbitant charges from physicians or hospitals that are not part of their insurance networks. The new federal legislation currently being drafted hopes to eliminate this issue and bring financial assistance to consumers.
Currently, consumers of health insurance in Plano, like many Americans, have been at risk for medical bankruptcies usually due to three types of scenarios:
1. Being treated for an emergency in an out -of-network facility. Typically, the patient is required by their insurance provider to pay out of their own finances.
2. Obtaining treatment by an out-of-network physician or health facility but is still within the patient’s insurance network. In some instances, a medical specialist may be needed and has an office at in-network facility but aren’t part of their insurance options requiring the patient to pay excess costs.
3. Emergency-room patients who incur large bills for receiving treatment at facilities that are not part of the insurance network.
The legislation would address these issues in a number of ways. For example, “balance billing” would be prohibited. This is the current practice requiring patients to pay the difference between their total bill and the cost if they had received treatment at an in-network provider. In many instances, providers have arbitrarily set costs with little recourse for patients to determine if the costs are reasonable or not. Also, the legislation would require emergency patients to receive written notification that they were being treated at an out-of-network facility and would provide them the option to choose an in-network once their condition stabilizes and allows for a transfer.
Finally, health insurance plans that are self-funded-when employers pay claims from their own company funds-would be covered by the new legislation. A majority of employees working in the private sector receive their insurance via self-funding which could minimize bankruptcies due to unforeseen medical bills.
Rick Thornton, a Plano health insurance agent, believes this legislation is good news for all involved. “High, unanticipated medical bills have always been a potential reality for many of the my clients in Plano. If the federal government can get involved and close some of these large gaps, individuals and families would be able to better plan their financial future and relieve quite a bit of anxiety”.
Health care recipients like those in Plano may not immediately see the changes in the legislation as it has to work it’s way through Congress but a positive sign is it already has bipartisan backing with Republicans and Democrats sponsoring the bill.
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